Modifiable Risk Factors For Stroke Prevention: Evidence-Based Intervention And Teaching Plan

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Modifiable Risk Factors for Stroke

Lifestyles and dietary patterns play a role in the prevalence of many preventable diseases, and identification of modifiable risk factors is important to promote behavioral change for people at risk of diseases. Based on the review of health history of the client’s health history from the milestone 1 assignment, the patient is at risk of stroke (preventable disease). This can be said because the patient has a history of hypertension and high cholesterol, which are medical risk factors for developing stroke. She is also taking aspirin and Clopidogrel medications to prevent stroke. One modifiable risk factor associated with the risk of stroke in a patient is an inactive or sedentary lifestyle. Physical activity is often targeted in a patient to prevent stroke and premature death (Arboix, 2015). The main purpose of the report is to identify one evidence-based intervention to eliminate the modifiable risk factors and develop a teaching plan for the patient to effectively utilize the intervention to promote health and well-being.

Stroke is a medical condition associated with sudden onset of weakness, paralysis, disturbed speech and aphasia caused the sudden interruption of blood flow to the brain area. This lack of blood flow to the brain mainly results because of blockage or narrowing of the arteries (Caplan, 2016). Some common symptoms include speech difficulty, paralysis, gait disturbance and blurred vision and the symptoms may vary individually based on the region of the brain which is affected. Smoking, high blood pressure, high cholesterol, and a diagnosis of diabetes also increases the risk of stroke. The presence of high cholesterol, hypertension and uncontrolled diabetes in the adult participant also helps to identify that the adult participant is at risk of stroke. Arboix (2015) explains that hypertension is the leading risk factor for cerebrovascular disease. Hence, controlling hypertension is necessary for prevention of stroke.

The diagnosis of stroke can be done by physical examination, blood test, CT scan, MRI or echocardiogram. A CT scan and MRI can help to get a detailed view of the brain and identify damage to the brain tissue caused by ischemic stroke and brain hemorrhage. In addition, blood tests can help to detect levels of blood sugars and blood clotting time to diagnose strokes (Urden, Stacy & Lough, 2017). Physical assessment to identify patients with stroke also includes getting the patient’s medical history, stroke’s cause and assessment of the degree of neurological deficit in the patient (Jarvis, 2016). Physical examination is essential to rule out differential diagnosis and identify the prognosis or complication in the patient (McGee, 2016).

Evidence-Based Intervention: Behavioral Strategies for Physical Activity Promotion

The adult participant is at risk of developing stroke because of the presence of several modifiable risk factors such as hypertension and diabetes. In patients with diabetes and hypertension, sedentary lifestyle is one factor that increases the risk of high blood pressure and cardiovascular disease. Lack of physical activity levels influence the mortality and morbidity related to chronic diseases (Ezeugwu, Garga & Manns, 2017). According to Saunders, Mead, Fitzsimons, Kelly,  van Wijck,  Verschuren & English, (2018) interventions to increase physical activity are the most common recommendation for stroke rehabilitation and secondary prevention. The study by Boysen et al. (2009) describes one evidence- based intervention to promote physical activity in patients at risk of stroke. It used behavioral approach to motivate stroke survivors to increase their physical activity levels. The main rationale for choosing this intervention was that it looked to address the barrier to participation in physical activity programmes and foster motivation in patient to promote behavioral change. The advantage of behavioral intervention is that tailored intervention can be developed to eliminate barriers and provide the right support for addressing sedentary behavior (Morris, MacGillivray, & Mcfarlane, 2014). These interventions can be most effective for patients at risk of stroke.

The study by Boysen et al. (2009) was a randomized, controlled trial which aimed to provide repeated encouragement and verbal instruction related to physical activity to the intervention group. In contrast, the control group received only information related to need for exercise without any specific instruction. The intervention group received in-depth instruction during the training sessions with trial physiotherapist. The first session focused on developing rapport with patients and evaluating their knowledge regarding risk of stroke. The aim of the first session was to identify most suitable physical activity for participants. In the next phase, the physical activity programme was individualized as per each patient’s resource, former activity level and preferences. Participants were encouraged to engage in physical activity by using fitness centers, walking, swimming and exercising in local center. Follow-up visits with participants were done every three months and every six months to reinforce the behavior. Telephone call was also used as a strategy to remind them about the physical activity arguments. The evaluation of changes in physical activity before and after the intervention revealed an improvement in walking ability; however no significant changes in physical activity. Hence, the intervention needs to be modified by including one or two specific exercises that promote behavioral change in patient.

Teaching Plan for Effective Utilization of Intervention

Based on this discussion, it is necessary that a nurse set effective care priorities for the client and identify a strategy that can increase the ease with which the adult participants can perform physical activity. The short term goal for care of patients will be to change attitude and behavior towards physical activity and to reduce hypertension and high cholesterol. The long term goal for patient will be to sustain positive behavioral change such as engagement in physical activity to reduce risk of stroke.

I plan to use the behavioral intervention to make the adult participants aware about the benefits of different exercises on health outcomes and increasing the chances of survival. However, based on initial session of interview with participants and identifying their capacity to engage in physical activity, I plan to provide the patient with only one structured physical activity plan to increase the effectiveness of the activity on health. As aerobic exercise has the potential to reduce all cardiovascular risk factors, the plan is to include aerobic exercise in the patient’s care plan to increase physical activity. Most stroke rehabilitation lacks training on aerobic exercise (Billinger et al. 2015). However, inclusion of these in the rehabilitation process can improve cardio--respiratory fitness and walking endurance. It is planned to provide all information to patient related to frequency, intensity and timing of the exercise as per individual assessment. Low intensity exercise will be provided to patient with no motor impairment, and high intensity will be provided to those who can sustain exercise for long duration.  

To evaluate the effectiveness of the teaching plan, follow up with participants will be done regarding adherence with the exercise session. Furthermore, improvement in physical activity level will be judged by number of hours spent in exercise and the barrier found during the process. Other important criteria for the success of the teaching plan will be to assess improvement in clinical indicators like hypertension and sugar levels.

The report gave an insight into the process of managing and preventing disease like stroke by addressing modifiable risk factors for the disease. Sedentary life style was regarded as one of the common causes behind risk of stroke. As physical activity is lacking in many stroke rehabilitation programs, the study utilized one evidence-based intervention related to behavioral strategies in order to change patient attitudes towards physical activity and promote behavioral changes in the patient.

References

Arboix, A. (2015). Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World Journal of Clinical Cases: WJCC, 3(5), 418.

Billinger, S. A., Boyne, P., Coughenour, E., Dunning, K., & Mattlage, A. (2015). Does Aerobic Exercise and the FITT Principle Fit into Stroke Recovery? Current Neurology and Neuroscience Reports, 15(2), 519. https://doi.org/10.1007/s11910-014-0519-8

Boysen, G., Krarup, L. H., Zeng, X., Oskedra, A., Kõrv, J., Andersen, G., ... & Winkel, P. (2009). ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial. BMJ, 339, b2810.

Caplan, L. R. (Ed.). (2016). Caplan's stroke. Cambridge University Press.

Ezeugwu, V. E., Garga, N., & Manns, P. J. (2017). Reducing sedentary behaviour after stroke: perspectives of ambulatory individuals with stroke. Disability and rehabilitation, 39(25), 2551-2558.

Jarvis, C. (2016). Physical examination & health assessment (7th ed.). St. Louis, MO: Saunders/Elsevier.

McGee, S., 2016. Evidence-Based Physical Diagnosis E-Book. Elsevier Health Sciences.

Morris, J. H., MacGillivray, S., & Mcfarlane, S. (2014). Interventions to promote long-term participation in physical activity after stroke: a systematic review of the literature. Archives of physical medicine and rehabilitation, 95(5), 956-967.

Saunders, D.H., Mead, G.E., Fitzsimons C., Kelly P., van Wijck F., Verschuren O., & English C. 2018. Interventions for reducing sedentary behaviour in people with stroke (Protocol). Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD012996.

Urden, L.D., Stacy, K.M. & Lough, M.E., (2017). Critical Care Nursing-E-Book: Diagnosis and Management. Elsevier Health Sciences